Violence Prevention in Healthcare: Safeguarding Worker Wellbeing and Patient Safety
Workplace violence in healthcare not only endangers medical staff but also negatively impacts mental health, patient safety, and the overall quality of care. As healthcare systems face increasing stress, it’s essential to prioritize violence prevention in healthcare to support a resilient workforce and safe care environments. This article explores ongoing efforts across government, industry, and institutions to address this critical challenge.
Understanding the Healthcare Workforce
Over 15 million individuals are employed in the U.S. healthcare system—including nurses, physicians, home health aides, EMTs, mental health professionals, and more. According to 2022 estimates:
- Women comprise 85% of healthcare support workers and 50% of physicians and dentists.
- Nearly 25% of support staff are Black.
- Many workers are aged 25–34, with 28% born outside the U.S.
Violence prevention initiatives must consider this diversity and ensure protections extend across roles, backgrounds, and identities.
Defining Workplace Violence in Healthcare
Workplace violence includes threats, verbal abuse, or physical assaults occurring on the job. It can be:
- Patient-related violence: from patients, family, or visitors
- Colleague-related violence: from coworkers, supervisors, or leaders
- Personal-relationship violence: involving intimate partners or relatives
Healthcare accounts for 14 nonfatal workplace violence injuries per 10,000 full-time workers—over three times the average across all industries. Though comprising only 10% of the workforce, healthcare workers experience 48% of nonfatal violence-related injuries.
The Impact on Mental Health and Wellbeing
Harassment and violence can result in serious psychological harm, including:
- Suicidal ideation
- PTSD
- Anxiety and depression
- Burnout
A CDC report found workplace harassment among healthcare workers more than doubled from 6% in 2018 to 13% in 2022. In response, NIOSH launched the Impact Wellbeing campaign, offering actionable guidance and resources for hospital leaders to reduce burnout and foster safe work environments.
Violence and Patient Safety: An Overlooked Connection
Patient and healthcare worker safety are deeply interconnected. The Agency for Healthcare Research and Quality (AHRQ) found that:
- Positive patient safety culture correlates with lower workplace violence and burnout.
- Reporting systems for violence help mitigate the impact of stress on patient care.
Surveys like AHRQ’s SOPS® now include workforce safety metrics focused on:
- Workplace aggression and hazards
- Staff training and leadership support
- Work stress and burnout prevention
Common Risk Factors for Violence in Healthcare Settings
Clinical Risk Factors
- Substance use disorders
- Pain management challenges
- History of violent behavior
- Cognitive impairment
Environmental Risk Factors
- Poor signage, noise, and lighting
- Lack of secure spaces or quick-response protocols
Organizational Risk Factors
- Inadequate training and awareness
- Absence of clear violence prevention policies
- Poor communication and safety culture
Co-Worker-Related Violence: Additional Risks
Individual Factors
- High stress and emotional strain
- Fatigue and burnout
- Poor conflict management skills
Systemic Factors
- Cost pressures and productivity demands
- Changing roles and rigid hierarchies
- Frequent staffing changes
Training modules like NIOSH’s Workplace Violence Prevention for Nurses offer guidance on identifying and managing these risks.
What Employers Can Do to Prevent Violence
Hospitals and healthcare facilities can play a pivotal role by:
- Engaging employees in safety planning
- Using OSHA’s workplace violence prevention guidelines
- Offering formal violence response training
- Implementing Joint Commission standards
- Collaborating with peer institutions on best practices
- Tracking incidents and integrating threat assessments into patient records
Real-World Hospital Efforts
Health systems report that violence and intimidation reduce care quality and staff performance. The American Hospital Association (AHA) has responded with:
- AHA Task Force strategies for supporting workforce wellbeing
- The Hospitals Against Violence (HAV) initiative
- The Building a Safer Workplace and Community framework
- Annual awareness events like #HAVhope Friday (June 7, 2024)
These initiatives promote cultural change, trauma-informed care, and accountability.
Government Efforts Supporting Violence Prevention in Healthcare
OSHA (Occupational Safety and Health Administration)
OSHA’s contributions include:
- The 2013 Hospital Safety and Health Road Map
- 2015 Violence Prevention Guidelines
- Internal audit checklists
- Regulatory engagement with small healthcare organizations
- Enforcement procedures for inspections
The Joint Commission
The Joint Commission has issued:
- Detailed workplace violence prevention standards
- A de-escalation guidance tool (Quick Safety 47)
- Updated standards for behavioral health and human services
NIOSH and AHRQ
- NIOSH continues its research through the Total Worker Health® and Traumatic Injury Prevention programs.
- AHRQ co-leads the National Action Alliance for Patient and Workforce Safety and supports systems-based funding for workplace violence solutions.